NatRevMD
Medical billing tips for healthcare professionals — by healthcare professionals.
This podcast is here to help private practices get paid what they’ve earned. We share real-world strategies for accurate coding, smoother billing workflows, and fewer denials — all from a team that’s been in your shoes. Whether you’re just getting started or trying to tighten up your revenue cycle, you’ll get practical advice you can actually use.
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NatRevMD
#131 Modifier 59 Explained: Correct Uses, Wrong Uses, and How to Avoid Costly Denials
Free Resource:
Make sure eligibility isn’t causing preventable denials. Download the free Eligibility Checklist → https://natrevmd.com/eligibility-billing-verification/
Modifier 59 is one of the most overused—and misunderstood—modifiers in medical billing. In this episode, Dr. Heather Signorelli breaks down exactly when 59 is appropriate, when it isn’t, and why using it on labs (like a UA) is a major compliance mistake.
You’ll learn:
- The real CPT and Medicare definition of modifier 59
- When to use 59 vs the X-modifiers
- Why adding 59 rarely changes payment but can flip denials
- The most common misuse patterns
- Clinical examples from urgent care, ortho, GI, and OB/GYN
- How to document a truly “distinct procedural service”
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Learn more at NatRevMD.com.